Clinicopathologic and prognostic features in appendiceal malignancies: does tumor invasiveness matter?
Kazım Şenol1,2, Murat Ferhat Ferhatoğlu3, Deniz Tihan2,4
1Department of General Surgery, Uludağ University School of Medicine, Bursa, Turkey
2Department of General Surgery, Bursa High Specialty Training and Research Hospital, Bursa, Turkey
3Department of General Surgery, Okan University School of Medicine, İstanbul, Turkey
4Department of Anatomy, Uludağ University School of Medicine, Bursa, Turkey
Objective: To evaluate the survival rates of appendiceal tumors and prognostic factors affecting survival.
Material and Methods: Demographic features, tumor characteristics and pre- and post-operative outcomes of the patients were analyzed retrospectively. The study was performed according to the Helsinki declaration.
Results: Twenty-three of the 2840 specimens were investigated prospectively. Median age of the patients was 28 (range: 1-89) years, with a male (n= 1730, 60.9%) to female (n= 1110, 39.1%) ratio of 1.55. Pediatric group did not present appendiceal malignancy. Carcinoid tumors were reported in 17 (0.59%) and adenocarcinoma was reported in 6 (0.20%) patients. Multivariate analyses of the subtypes showed serosal invasion as an independent risk factor for mucinous and non-mucinous adenocarcinoma (HR: -2.70, 95% CI: 0.006-0.755, p= 0.029). Median follow-up time was 48 months (range: 28-61 months) and disease specific survival rates of carcinoid tumors, mucinous- and non-mucinous adenocarcinomas were 36(95% CI 32-40), 30 (95% CI 13-46), 43 (95% CI 30-55) months, respectively (p= 0.749). Factors affecting survival in the univariate analyses were advanced tumor stage, serosal invasion and tumor invasion depth. In multivariate analyses, tumor invasion depth was the only independent prognostic factor with poor survival rates in all subtypes of appendiceal malignancies (HR= 1.31 (95% CI: 1.01-13.5), p= 0.047).
Conclusion: Tumor subtype and tumor invasiveness are important risk factors for survival. Besides other treatment modalities, appendectomy still remains the survival benefit with better clinical outcomes.
Keywords: Appendectomy, appendicitis, appendiceal malignancies, appendiceal tumors
Cite this article as: Şenol K, Ferhatoğlu MF, Tihan D. Clinicopathologic and prognostic features in appendiceal malignancies: does tumor invasiveness matter? Turk J Surg 2019; 35 (4): 245-251.
Ethics committee approval was received for this study from the Ethics Committee of Yüksek İhtisas Training and Research Hospital.
Written informed consent was obtained from patients who participated to the study.
Concept - K.S., M.F.F., D.T.; Design - K.S., D.T.; Supervision - K.S., M.F.F., D.T.; Resource - K.S., D.T.; Materials - K.S.; Data Collection and/or Processing - K.S., D.T.; Analysis and/or Interpretation - K.S.; Literature Search - K.S.; Writing Manuscript - K.S.; Critical Reviews - K.S., M.F.F., D.T.
The authors have no conflicts of interest to declare.
This research was supported by Bursa State Hospital and Yüksek İhtisas Training and Research Hospital.
We thank our colleagues from General Surgery Department who performed the operations. We also thank to the anonymous referees for their useful suggestions.